Thinking about TRT and could use some guidance

[madman]

Thanks for this. I was under impression that 200mg/wk was the usual minimum effective starting dose so 100mg would be a conservative dose. If I do decide to go with TRT I will start at 50mg/wk and check levels in 3 months to see how things are going.

Post in thread 'Starting TRT Soon'

May 17, 2025

Bump

Took my third shot on Friday. After a quick libido boost, it went dead and has been the last couple of days yesterday and today I’m much more irritable and moody, energy is pretty decent. I know it’s early but I’m already wondering if 120 a week is too much of a starting test and I should bump it down to 100.

As I stated previously the standard starting dose is 100 mg T/week which is a sensible starting dose for most!

Could name off numerous uros considered top of the field in this game where it is a common starting dose.

It's far from an ABSURD dose!

Can some men start...

• madman

 

[JSMITH1976]

A total of 24 male subjects completed the report indicating different symptoms related to sexual functions that persisted after finasteride use. In line with previous reports, 92% of patients claimed erectile dysfunction and loss of libido, 44% genital anesthesia and 32% watery ejaculation and testicular atrophy.

This isn't a real study but self reporting of 24 people. In my personal case the initial ED, loss of libido have resolved. Never had genital anesthesia nor noticed testicular atrophy (although initially I did have testicular pain now fully resolved). The only thing I do have is watery ejaculate.

 

[JSMITH1976]

Testosterone helps a little, very indirectly and inefficiently compared to a GLP-1. The degree of self-discipline required to get lean is not significantly reduced by testosterone - every obstacle to leanness that currently exists in your life will remain, looming large as ever.

Agreed completely. I have managed to lose 50lbs over the last three years without drugs or surgery. I am als0 maintaining the loss so I am not looking at TRT as magical cure for weight loss.

As badassblues said, you lose equal parts muscle and fat on a GLP-1 when you take the drug and do literally everything else wrong. If you prioritize protein and resistance training, you are going to shift the balance of weight lost to be largely fat, even without hormonal assistance. This is the tool for the job when the goal is fat loss.

Yes, exercising helps maintain muscle on GLP-1s jut like it does with general dieting and fasting. However, unless you are working out really hard it is unlikely that most people, specially the overweight/morbidly obese, will be able to keep up with the pace of muscle loss.

If you were not taking finasteride, I would be more optimistic that testosterone would help. The combination of finasteride with testosterone will serve to block many of the benefits of TRT. Aside from building muscle, testosterone doesn't have much useful action on its own - it acts primarily by conversion to its metabolites DHT and estradiol. So, with finasteride on board, you take the already low chance that TRT improves symptoms in someone with your levels and reduce it further by blocking the sizeable fraction of the benefits that derive from DHT.

That's interesting. DHT is a more "active" hormone then T but only about 10% of T is converted to DHT and in adult males its function is quite limited as far as we know. Of course in a 15 year old this would be a much different discussion. Frankly, I am not keen on taking T. I was just surprised my MD would suggest it given my generic symptoms and normal lab values. This is more why I am looking into it then either starting or not.

We can't prove that finasteride versus stress are causing your issues. I would say they are about equal as likely causes, and there may be contributions from both. Stopping finasteride to see whether that has an impact would be much easier than stopping the stress though, wouldn't it?

Yes. But the better choice is to improve the stress. However, I concede your point.

What do you have to lose, besides a little hair that you were going to lose later anyway?

Between bald and a little more muscular and dad bod with a full head of hair I am going for the latter . Thanks for all the info.

 

[BadassBlues]

This isn't a real study but self reporting of 24 people. In my personal case the initial ED, loss of libido have resolved. Never had genital anesthesia nor noticed testicular atrophy (although initially I did have testicular pain now fully resolved). The only thing I do have is watery ejaculate.

I understand that one of your top priorities is your hair. I share that concern with you. Since you have dug in to defending what is widely regarded as one of the worst drugs for men to take, I will leave you with this and wish you the best of luck. The entire study can be found here:

Multidimensional assessment of adverse events of finasteride：a real-world pharmacovigilance analysis based on FDA Adverse Event Reporting System (FAERS) from 2004 to April 2024 - PMC

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to ...

pmc.ncbi.nlm.nih.gov

Abstract​

Background​

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to evaluate the AEs associated with finasteride use, based on data from the US Food and Drug Administration Adverse Event Reporting System (FAERS), to contribute to its safety assessment.

Methods​

We reviewed AE reports associated with finasteride from the US Food and Drug Administration Adverse Event Reporting System database, covering the period from the first quarter of 2004 to the first quarter of 2024. We assessed the safety of finasteride medication and AEs using four proportional disproportionality analyses: reported odds ratio (ROR), proportionate reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPN), and Multi-Item Gamma Poisson Shrinkage (MGPS). These methods were used to evaluate whether there is a significant association between finasteride drug use and AEs. To investigate potential safety issues related to drug use, we further analyzed the similarities and differences in the onset time and AEs by sex, as well as the similarities and differences in AEs by age.

Results​

A total of 11,557 AE reports in which finasteride was the primary suspected drug were analysed. The majority of patients were male (86.04%) and a significant proportion were young adults aged 18-45 years (27.22%). A total of 73 different AEs were categorised into 7 system organ classes (SOCs), with common AEs including erectile dysfunction and sexual dysfunction. In addition, we identified previously unlisted AEs, including Peyronie’s disease and post-5α reductase inhibitor syndrome. Of the reported AEs, 102 occurred in men and 7 in women, with depression and anxiety being significant AEs observed in both sexes. When analysed by age group, there were 17 AEs in patients aged ≤ 18 years, 157 in patients aged 18-65 years and 133 in patients aged ≥ 65 years. Common AEs in all age groups included erectile dysfunction, decreased libido, depression, suicidal ideation, psychotic disturbances and attention disorders. The median time to onset of all AEs was 61 days, with the majority occurring within the first month of treatment. Notably, a significant number of AEs persisted beyond one year of treatment.

Conclusion​

The results of our study uncovered both known and novel AEs associated with finasteride medication. Some of these AEs were identical to the specification, and some of them signaled AEs that were not demonstrated in the specification. In addition, some AEs showed variations based on sex and age in our study. Consequently, our findings offer valuable insights for future research on the safety of finasteride medication and are anticipated to enhance its safe use in clinical practice.

 

[JSMITH1976]

You posted your TT and more importantly FT but you never even stated what testing method was used for the most critical fraction free testosterone.

Always post the testing method used/reference ranges!

This is critical!

This is a fair point. It was done in the US at Quest Diagnostics with a blood draw, fasting, early in the morning (applies to both sets). It is a chromatography/mass spectrometer assay. gThe number is actually 93 pg/ml so that works to 9.3 ng/dl. The normal range for this lab/test is 3.5 ng/dl to 15.5 ng/dl.

 

[Seagal]

I understand that one of your top priorities is your hair. I share that concern with you. Since you have dug in to defending what is widely regarded as one of the worst drugs for men to take, I will leave you with this and wish you the best of luck. The entire study can be found here:

Multidimensional assessment of adverse events of finasteride：a real-world pharmacovigilance analysis based on FDA Adverse Event Reporting System (FAERS) from 2004 to April 2024 - PMC

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to ...

pmc.ncbi.nlm.nih.gov

Abstract​

Background​

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to evaluate the AEs associated with finasteride use, based on data from the US Food and Drug Administration Adverse Event Reporting System (FAERS), to contribute to its safety assessment.

Methods​

We reviewed AE reports associated with finasteride from the US Food and Drug Administration Adverse Event Reporting System database, covering the period from the first quarter of 2004 to the first quarter of 2024. We assessed the safety of finasteride medication and AEs using four proportional disproportionality analyses: reported odds ratio (ROR), proportionate reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPN), and Multi-Item Gamma Poisson Shrinkage (MGPS). These methods were used to evaluate whether there is a significant association between finasteride drug use and AEs. To investigate potential safety issues related to drug use, we further analyzed the similarities and differences in the onset time and AEs by sex, as well as the similarities and differences in AEs by age.

Results​

A total of 11,557 AE reports in which finasteride was the primary suspected drug were analysed. The majority of patients were male (86.04%) and a significant proportion were young adults aged 18-45 years (27.22%). A total of 73 different AEs were categorised into 7 system organ classes (SOCs), with common AEs including erectile dysfunction and sexual dysfunction. In addition, we identified previously unlisted AEs, including Peyronie’s disease and post-5α reductase inhibitor syndrome. Of the reported AEs, 102 occurred in men and 7 in women, with depression and anxiety being significant AEs observed in both sexes. When analysed by age group, there were 17 AEs in patients aged ≤ 18 years, 157 in patients aged 18-65 years and 133 in patients aged ≥ 65 years. Common AEs in all age groups included erectile dysfunction, decreased libido, depression, suicidal ideation, psychotic disturbances and attention disorders. The median time to onset of all AEs was 61 days, with the majority occurring within the first month of treatment. Notably, a significant number of AEs persisted beyond one year of treatment.

Conclusion​

The results of our study uncovered both known and novel AEs associated with finasteride medication. Some of these AEs were identical to the specification, and some of them signaled AEs that were not demonstrated in the specification. In addition, some AEs showed variations based on sex and age in our study. Consequently, our findings offer valuable insights for future research on the safety of finasteride medication and are anticipated to enhance its safe use in clinical practice.

The following article was cited:

https://pubs.acs.org/doi/10.1021/acs.jmedchem.0c02039

Finasteride, a 5-alpha reductase (5α-R) inhibitor, is a widely used drug for treating androgen-dependent conditions. However, its use is associated with sexual, psychological, and physical complaints, suggesting that other mechanisms, in addition to 5α-R inhibition, may be involved. Here, a multidisciplinary approach has been used to identify potential finasteride off-target proteins. SPILLO-PBSS software suggests an additional inhibitory activity of finasteride on phenylethanolamine N-methyltransferase (PNMT), the limiting enzyme in formation of the stress hormone epinephrine. The interaction of finasteride with PNMT was supported by docking and molecular dynamics analysis and by in vitro assay, confirming the inhibitory nature of the binding. Finally, this inhibition was also confirmed in an in vivo rat model. Literature data indicate that PNMT activity perturbation may be correlated with sexual and psychological side effects. Therefore, results here obtained suggest that the binding of finasteride to PNMT might have a role in producing the side effects exerted by finasteride treatment.

Didn't know about this.

 

[JSMITH1976]

Thanks everyone for all the input. Certainly lots of good information. I will be reviewing the articles some more and then having another discussion with my MD. At this point I am leaning toward NOT starting TRT as it doesn't seem to hold any/very few benefits for me. Thanks again.